Research Reports - Traumatic brain injury may be an independent risk factor for stroke
Neurology. 2013 Jul 2;81(1):33-9
Burke JF, Stulc JL, Skolarus LE, Sears ED, Zahuranec DB, Morgenstern LB
OBJECTIVE: To explore whether traumatic brain injury (TBI) may be a risk factor
for subsequent ischemic stroke.
METHODS: Patients with any emergency department visit or hospitalization for TBI
(exposed group) or non-TBI trauma (control) based on statewide emergency
department and inpatient databases in California from 2005 to 2009 were included
in a retrospective cohort. TBI was defined using the Centers for Disease Control
definition. Our primary outcome was subsequent hospitalization for acute ischemic
stroke. The association between TBI and stroke was estimated using Cox
proportional hazards modeling adjusting for demographics, vascular risk factors,
comorbidities, trauma severity, and trauma mechanism.
RESULTS: The cohort included a total of 1,173,353 trauma subjects, 436,630 (37%)
with TBI. The patients with TBI were slightly younger than the controls (mean age
49.2 vs 50.3 years), less likely to be female (46.8% vs 49.3%), and had a higher
mean injury severity score (4.6 vs 4.1). Subsequent stroke was identified in 1.1%
of the TBI group and 0.9% of the control group over a median follow-up period of
28 months (interquartile range 14-44). After adjustment, TBI was independently
associated with subsequent ischemic stroke (hazard ratio 1.31, 95% confidence
CONCLUSIONS: In this large cohort, TBI is associated with ischemic stroke,
independent of other major predictors.